ABC News: Get Your Facts Straight on Costs of Low Breastfeeding Rates

In reporting on a just-released study showing that low breastfeeding rates costs us at least $13 billion annually and 900 infant lives, ABC News is missing some important facts. The ABC News story differs markedly from the Associated Press story, which we think does a better job of reporting on the study. For a link to the original study, published online in Pediatrics by our friend Melissa Bartick, MD, click here. We are thrilled with the study and hope it will provide the impetus for more studies along the same lines. Only when our culture truly appreciates breastfeeding, and truly understands the barriers, will more pressure be applied to the “Booby Traps” instead of to moms!

Here’s our response to the slanted article by ABC News:

ABC News: “A new study calculates the cost in the United States of not breastfeeding infants in their first six months of life at $13 billion each year [. . . ] but the study fails to consider the costs of what would be needed to make breastfeeding easier for mothers. ”

BfB: 1. The AAP, ACOG and others have already asked Congress for breastfeeding infrastructure budget of $15 million to raise breastfeeding rates. That is less than 1% of what could be saved! See our post from March 19th (2 weeks ago!) http://www.bestforbabes.org/2010/03/aap-acog-aafp-wic-ask-congress-for-15million-bfing-budget/ Very little money is currently being spent by Congress on a coordinated approach to remove the breastfeeding “booby traps” –the cultural, social, and institutional barriers that keep the 86% of expecting mothers that say they WANT to breastfeed from achieving their personal breastfeeding goals. Surely $15 million would be a worthy investment to save 900 lives and billions in medical costs? Even 100 times that, at $1.5 billion, seems like a good deal. $1.5 billion is still only about half what the formula industry spends annually on marketing and advertising.

2. The study, while a huge improvement on the previous study measuring the cost for 3 pediatric illnesses, only takes into account 10 pediatric illnesses. How many billions could be saved on all pediatric illnesses? How many billions could be saved on maternal illnesses like breast cancer, diabetes, obesity, rheumatoid arthritis? How many billions could be saved on a reduced environmental burden? How many billions could be saved on missed days of work, lower employee morale?

ABC News: “The biggest barrier to mothers continuing to breastfeed seems to be the fact that more mothers are in the workplace,” said Dr. Lillian Beard, an associate clinical professor of pediatrics at the George Washington University School of Medicine and Health Sciences and an assistant professor at the Howard University College of Medicine. [. . . ] ‘I think this report puts an unfair slant on it,’ Beard said. “It’s not taking into account that for almost two thirds of U.S. families, women are either the co-breadwinner or the breadwinner. Returning to work is germane for the survival of the family.” Beard said that while a majority of women may want to breastfeed, outside constraints make it difficult and there is a drop-off in breastfeeding once they have to return to work.

A real "booby trap". Not far from what moms are experiencing.

BfB: Actually, the biggest barrier to continuing to breastfeed is not the workplace, but the fact that 70% of hospitals perform poorly on breastfeeding support. If moms can’t even make it through the firt few days without 25% of healthy, full-term babies being unnecessarily supplemented, often against the parents wishes, how are they supposed to continue breastfeeding when they go back to work? Unnecessary supplementation is a “booby trap” that undermines the supply and demand mechanics of breastfeeding, wrecks the baby’s latch, gets breastfeeding off to a lousy and often painful start, and is practically guaranteed to make moms want to throw in the towel. And we don’t blame them.

ABC News: “Probably, many of the costs to get breastfeeding that high would be social, not medical expenses,” [says Rebecca Goldin, an associate professor of mathematical sciences and director of research for the Statistical Assessment Service at George Mason University], including compensating employers for giving women time to breastfeed and having social workers visit homes to help new mothers with nursing. “Those are very real costs,” said Goldin. “When you do an economic comparison, it’s unfair to only look at one aspect of the cost for any one particular decision. It’s not clear that this is a fair savings to the nation.”

BfB: We already addressed some of the cost issue above. But compensating employers??? Is Professor Goldin aware that employers save between $2 and $3 for every $1 invested in lactation programs? Perhaps she should read about the Business Case for Breastfeeding in the FAQs just issued by the United States Breastfeeding Committee in response to the passage of the Health Care Reform package.

ABC News: “Although breastfeeding is absolutely ideal, for the mothers who cannot and choose not to breastfeed, infant formula is what’s recommended,” [says Dr. Lillian Beard, an associate clinical professor of pediatrics at the George Washington University School of Medicine and Health Sciences and an assistant professor at the Howard University College of Medicine]. “I don’t want to beat her over the head with guilt. I let her know that infant formula is the safest, most nutritious and only recommended alternative to her milk.”

BfB: 1. Breastfeeding is not “ideal,” it is as normal as learning to walk and in the same way includes a learning curve and requires time, patience and lots of support. Painting breastfeeding as an “ideal” is a “booby-trap” because most parents, and most people, really, find striving for an ideal to be impossible. Personally, I am just getting by as a parent by the seat of my pants and doing the best job I can; if I had to attain an “ideal” I would have jumped out the window long ago.

2. Infant formula is NOT the only recommended alternative, in fact it is in last place among recommended alternatives. Expressed breastmilk from the mother is first in line, and donated, screened, pasteurized human milk from a registered milk bank is recommended above infant formula, which should only be used as a last resort according to the World Health Organization.

3. Women who can not breastfeeding should not be stigmatized; they should have access to donor milk. However, far too many women are being “booby-trapped” by doctors like Dr. Beard, who portray breastfeeding as an “ideal” instead of inpiring, preparing and empowering mothers to succeed. Great doctors neither guilt nor undermine their patients; they inspire them with confidence, and cheer them on much as a good coach, or at least refer them to an excellent lactation counselor. Furthermore, too many moms are duped into believing they can’t breastfeed by poorly trained hospital staff, by hospitals operating with conflicting agendas because they receive millions of dollars in funding from the formula industry.

I find it disappointing but not uprising that ABC News would put a negative spin on this new breastfeeding study. It’s another perfect example of how the news media and entertainment industry negatively affect breastfeeding and birth in America. I’m sure that the money needed to improve breastfeeding rates in the US would be much much less than $13 billion. The positives directly related breastfeeding are worth whatever amount of money needs to be spent to increase breastfeeding success in America.

This clarification is so important. As the acting Surgeon General said last June at the 1st Annual Summit on Breastfeeding, “the debate is over!” Mothers should breastfeed their babies. Barriers should be removed so this can be accomplished. The Academy of Breastfeeding Medicine is working with physicians worldwide to ensure that this happens. Both the science and the leadership are necessary, but “the debate is over!”

I am a hospital based IBCLC and just this week I have to fight to keep my job. I am the only IBCLC and we deliver about 1,500 to 2,000 babies a year with a 73% breastfeeding rate.The hospital wants to cut my hours from 30 hours a week down to 20 hours a week. Once there are budget cuts an IBCLC job is always the first to get cut, especially in NY. Because there is no legislation on the ratio of IBCLCs to patients in either federal or JACO this will continue. Women need to start boycotting hospitals that do not have IBCLC full time coverage. Women are the consumers here and it is time we speak up to the hospitals and demand this service when a baby is born. This service is more important then a pretty room!

A woman I was talking to said once to me that feeding babies formula was like feeding them Pringles. Harsh, but really it struck home to me. It is hard work, but if it’s painted as a lifestyle choice than the alternatives are seen as just that. Thanks for clarifying with this piece!! if breastfeeding is seen as a necessity for the future well-being of your child than you do all you can to make it happen. It’s down to employers in the end to support it, and women in all areas of society to demand to have the right feed their children.

I just wanted to respond to your allegation on Blacktating that Dr. Goldin is “related to the formula industry”. Unless things have changed in the past 6 months, I met with Rebecca Goldin last fall and did my research on her – she is 100% committed to NOT being in bed with Big Formula. In fact, when I approached her about participating in a project I was working on that could be construed as pro-formula, she was adamant about it not being connected or funded by formula companies. The woman is one of the coolest, most moral people I’ve ever met, who breastfed all 4 of her kids for over a year each, incidentally.

Accusing anyone who questions the breast-is-best-at-all-costs rhetoric just weakens your admirable cause. I admire you so much, Bettina – you are everything that is good about lactivism – so I hope these aren’t blind accusations. Do you have any concrete proof?

Thank you for your kind words. First of all, Best for Babes does not believe that breast-is-best-at-all-costs either so we have no problem with anyone questioning that rhetoric! We don’t like the slogan “Breast is Best” because we believe it does mothers a great disservice by idealizing breastfeeding. Breastfeeding is normal, but it is not appropriate in a number of situations, and we stand behind every mother’s right to make an informed feeding decision and to carry that out whether that decision is to feed formula, donated milk from a milk bank, to breastfeed, or some combination of all.

As to Dr. Goldin, her quotes in the ABC News article don’t hold water, which is why I wrote this post. Her position is sufficiently outlandish that it draws attention to her and invites critical examination both of her work, and of the institutions with which she is affiliated, by researchers and scientists we respect (the information we received came from a national watchdog organization). But I am less interested in going down the rabbit hole of her affiliations and prefer to stick to the confusing points she made in this story. While I respect that you may genuinely like and admire her, I hope you will join me in questioning her position on this issue, as it serves neither breastfeeding nor formula-feeding mothers. I hope you will also question why ABC News chose two “experts” who are not seen as independent in the medical/scientific community, and why they chose to lead the story with such a negative slant. From what I understand, it is standard to present the facts of the story first and then raise questions or concerns later.

What about the $$$ spent by the US Govt. to subsidize formula for low income moms through WIC? By defintion, if the goal of 90% exclusive breastfeeding for 6 months were achieved nearly all of that expense would be saved.

Regarding guilt, I am of a similar mindset as Dr. Jack Newman in his book, “The Ultimate Breastfeeding Book of Answers,” when he argues that women should be made to feel guilty for not breastfeeding. I am quoting him directly (pg. 39):

“But we certainly make mothers feel bad about their choices in many other situations. If you are a smoker and your child has asthma, it is probable that you will leave your physician’s office feeling guilty. If you are pregnant and you drink alcohol, even small amounts, you will probably leave your doctor’s office with stern warnings ringing in your ears and guilt in your heart. Tell the doctor you aren’t planning to use a car seat when you take your baby out in the car, and you’ll get another dose of guilt. Why would the physician do that? Because he or she really believes that your continuing to smoke or drink alcohol may harm the baby.
Obviously, the physician who says that we should not make mothers feel guilty for not breastfeeding doesn’t believe that breastfeeding makes a difference. But lots of evidence indicates that it does—for the mother, for the baby and for society.”

Breastfeeding takes time, effort, determination. Making a bottle is far, far easier than taking 8-10 weeks to get a baby to learn to effectively breastfeed.

Well, technically, as Melissa Bartick is the chair of the Mass Breastfeeding Coalition, she’s not truly “independent” either. I would imagine that her commitment to her cause would skew her bias a little, no?

I’m not trying to pick a fight at all… I think we are truly on the same side here. I just get itchy about this issue b/c it seems that EVERY time anyone says anything even slightly pro-formula, they get accused of being in the pocket of the formula industry. And while I understand that being part of a pro-breastfeeding coalition may not offer any monetary gain, it speaks to a certain POV that could color a scientific study just as easily as a loose association with a formula company.

FWIW, I also really don’t believe that consulting for Big Formula means that you can’t have an opinion. If you respect someone’s professional ethics, you should trust that if they are not speaking on behalf of a formula company but from their personal beliefs/research, then they are not coming from a compromised position. EVERYONE has associations that could be perceived as bias nowadays. Research costs money. Sucky but true.

The driving analogy may hit home with most Americans, since most live in places where there is no option. But the costs of formula feeding and the costs of driving need to be compared in situations where there ARE options (that is, where public transport and breastfeeding get the support they need). Both have such high health costs and environmental costs that the creation of reasonable options is a public good and deserves the use of public (tax) funding. Compared with nearly all other industrialized countries, the US spends far too little on both and is paying high long-term economic, environmental and social costs for being so short-sighted.

Rebecca Goldin was the first author of that wretched piece at stats.org about breastfeeding being overhyped. (This was from 2006, which is approx. 269 internet years ago, so here’s a link.) So they solicited opinions from someone who gets paid by a formula company and someone known to be a skeptic about breastfeeding research. Maybe they should have called up Amy Tuteur to make it a Credentialed But Nonetheless Wrong hat trick.

Wonderful review – as stated, most employers are not to blame for women not breastfeeding, most women have stopped prior to returning to work for many reasons, including poor support in most hospitals. If we can get a breastfeeding woman back to work after delivery, she will have lower absenteeism rates, higher motivation, lower health care costs and the employer benefits from all of these factors plus a family friendly reputation. It is great to have some current, solid, well researched price tags placed on breastfeeding. We can all then work together to benefit the most women and children.

Very good review. I do have one comment in that many women do face a hard time continuing breast feeding when they return to work. Even if breast feeding is well established and has become easy for the mom and baby, many jobs do not allow the time or place for pumping. I’ve had friends of mine who have had to pump in bathrooms, or have been told they can only pump during their luch break. How do you keep up a milk supply with one pumping during an 8 hour time period? I have received bad looks from co-workers when I put my milk in the refrigerator (and it’s already in a lunch bag cooler before I get to the kitchen). I somewhat agree with ABC’s comment about the workplace making it difficult for moms to continue nursing. I

First of all, what study? who did it? how did they come up with these number? While I did breasfeed my kids for some time, with success and joy, the pumping thing at work was a pain, not compatible with a normal work day that doesn’t revolve around breaks, especially when you have a baby at home and want to be home on time. If I could produce 4 to 6 oz during the day that was it, thus making formula a very reasonable alternative. Not every mother can or want to be with a baby 24/7. Nobody came in the way of my breastfeeding, not even my boss. But when I am at work, I… work. Formula has helped more than one mother and baby, and is a reasonable. Alternative. Quid of all the parents who lives in poluted area, drive too fast, don’t feed them the perfect diet, send them to the war etc… Health and longevity is a combination of factor, breastfeeding being one of them.

I just found this blog and am appreciative of the many comments that people made. Since I am the subject of some of the conversation I thought I would clarify a couple points:
1) I am not and have never been funded by any industry sources, and in particular I have definitely not accepted any money or anything else from the formula industry or any of its representatives. It is completely fair to be suspect of industry sources—and this is why I go out of my way to be sure my slat is clean (the organization where I am Director of Research, http://www.stats.org, does not accept industry funding – only foundational or grant money allowed). Though I believe that sometimes people “change their view” in order to be appealing to industry, I think it’s more common that those who have industry-sympathetic opinions are supported more by industry. The reason I don’t want anything to do with this industry is IN ORDER to have a voice that is not even potentially biased by financial interest. However, one should not dismiss the content of those who have a financial interest — rather be suspect of it. For example, I will not categorically dismiss the opinion of a lactation consultant because she makes money on being a lactation consultant! My experience is that most people really believe in what they do, including people who work for formula companies and people who sell Medela breast pumps!
2) FFF is correct: I have nursed all four of my children. This was, for me, both joyful and frustrating, a huge investment in time and energy (and therefore money) and a very intimate and meaningful thing for me. I had quite a lot of trouble with my first, including bleeding and cracking and excruciating pain, but I felt I had “imagined” myself doing it, so I kept on. So this conversation is NOT about my lack of appreciation for what nursing is.
3) Regarding the economics: I simply disagree wholeheartedly with the comments that it’s not expensive to increase breastfeeding in the US. As the nurse who works with new mothers knows, women like her are too few and far between. And since milk often doesn’t come in for a few days, hospital support alone may not be sufficient. And, purely from a financial point of view, the US government would lose tax revenue as well if women stay home to nurse. From an individual point of view, it makes even less sense: the personal financial benefit of work, even at minimal wage, eclipses the cost of formula.
4) Several people mentioned the outrage of the idea that anyone could make a decision based on the finances or convenience when, according to the ASSUMPTIONS of the Pediatrics article, there are babies dying. I want to address this head on. There are two issues: one is whether there really are babies dying in developed countries caused by not nursing, and the other is whether, if we acknowledge that the numbers are right, it is therefore unethical not to nurse.

To the first point: As someone mentioned in a rather derogatory way, I am skeptical that the deaths are truly attributable to not nursing. There are so many differences between women/families who nurse and those who don’t that it is difficult to compare them and know that you can attribute a death to whether they nursed or not. It’s not like a car accident or cancer where you can directly assign the death to a cause. One example that made this very clear to me is that “never nursing” as compared to “ever nursing” is associated in one major study with an increased risk of dying due to *injury*. What could be the mechanism for this? It could be that women who nurse are more careful, or that the research did not control for some important difference (perhaps among those who never nurse, there is a larger group, though still a small minority, of abusive parents – this theory is upheld by some scientific evidence that I will not go into here). This study was the main study referenced in the 2007 conclusions about deaths associated with not nursing. The authors suggested that the “mechanism” could be that nursing mothers hold their babies closer and are more bonded. This of course could well be the mechanism — in which case expressed milk is also a bad idea since it’s still being fed via a bottle. I am not saying this research is *wrong*. I am saying that it is not conclusive, and doesn’t by itself suggest nursing (rather than some other mechanism) is in play. The possibility of an unknown confounder like abuse seems as likely as any other to explain this strange result. Other forms of death, by the way, in children under 1 were *not* associated with never-nursing with statistical significance (though there was a trend that did not reach the technical definition of significance). I think it’s unreasonable to say that formula makes a baby more prone to accidents. This is only one aspect of the deaths that were attributed (in my opinion, unfairly) to not nursing. There are similar kinds of bias (bias in the statistical, not social, sense – I think most researchers were trying to do their studies carefully) in other studies, which makes me a skeptic for some of the benefits of nursing. Though I am not a skeptic of all benefits – there are well done studies showing that nursing decreases ear infections and gastrointestinal infections – however, these infections are not generally life threatening.

Now to the second point. Is it unethical to decide not to nurse if you think the quality of the research on nursing is good and the results accurate? In my opinion, no. Risk is everywhere and we cannot deny its importance in our lives and our decisions. Everyone knows what a tragedy it is when a baby or a young child dies. But we also make decisions that cost young lives *all the time*. Driving IS one of these, and I think a very appropriate analogy. Kids who are in car seats and properly restrained also die every year — and while the numbers are very small, they are comparable to those that are attributing to not nursing (if you take the research for not nursing at face value and don’t question it as I do). I am not talking about kids just hanging in the back seat – I am talking about children under 1 who are in a car seat. So who has decided never to drive for fear that they might kill their child? And who would accuse a family who does lose a child when driving of being negligent if they used proper child seats?

Efforts involved with getting women to nurse more are VERY WELL PLACED, except when they involve emotional blackmail. Women don’t need to think they are doing bad for their child by not nursing any more than we should feel guilty about living in a place in which driving is a daily activity and even some argue a necessity. What they do need is support for their decisions, and encouragement to give nursing a try. This involves support in the hospitals, support in the work environment and women’s groups who are supportive of where they are with the issue, not critical of their needs.

Most well-educated wealthy women *do* nurse for at least a short time. The problems of not nursing are related to poverty, both at the level of hospital and staff support, and also in terms of maternal leave and follow-up support/social services. Increasing the participation of women to nurse take more than guilt, it takes a substantial public investment. Currently, nursing has financial consequences that hit the poorest hardest. One person commented that WIC shouldn’t give women formula (that this was a sign of industry corruption). I couldn’t disagree more: formula is a safe alternative to nursing, and milk and cereal at too young an age is not. It would be a disaster if women who can’t afford formula used regular milk. If one wants to turn to financial incentives to encourage women to nurse, one has to come up with an idea that does not encourage them to use unsafe products instead, as opposed to using formula.

When I first walked into a pediatrician’s office (before my first child was born) I was told that I absolutely should nurse for the first 4 months of his life. I think it would have been equally reasonable for the pediatrician to suggest that I consider a moratorium on driving for as long as possible, and/or a variety of lifestyle choice that might decrease the chance of my child being at risk – maybe move out of DC where there is random violence and pollution, and into a small town where driving is unnecessary. In a way, I personally would have appreciated a comment about *what the risk is* without so much judgment about whether the pediatrician thinks that my decisions are too risky or not.

Thanks for writing in, but honestly I wonder whether you read the blog post at all, as you have not responded to points I made about your quotes and those of Dr. Beard. I would be happy to engage in a dialogue with you if you can address the points I made, not those made in the comments. I also urge you to look beyond the cost of a can of formula vs. minimum wage, that analysis seems overly simplistic to me and does not take into account other costs, nor does it take into account quality of life. If governmental support of breastfeeding were truly so prohibitive, I don’t think countries like Germany and Sweden would have been able to keep it up! These countries have a lot of indicators (infant mortality, etc.) that are vastly better than ours and there is a reason for that. Why don’t we join up for an experiment . . . if you can persuade the government to allocate $15 million to raising breastfeeding rates, and uphold the WHO Code, I will prove that it saves far more!

Yes of course I did read the original blog post. And I would love to get the government to spend $15 million on the cause of my choice — if only I had such power!

Regarding your points: you disagreed with the idea that working is an impediment for nursing, citing a news report that 1 in 4 healthy babies are given supplements in medical centers. Your response is not relevant to the question: even if 25% are given supplements, more than 80% of women stop nursing soon after they leave the hospital, so there is clearly something else going on! I don’t know of any surveys in which women are asked why they stopped nursing/never started nursing (maybe you do) but I don’t think it’s mainly because they had a can of free formula (though maybe for some, this was the reason). My own conversations with many women is that the reasons are a combination of the difficulty of nursing (which speaks to the need for support and to your point about resources) and the fact that they felt it was difficult to be professional and also to pump (which speaks to working). But of course, my experience in speaking with people is just my own demographic.

You also stated that 15 million would be worth it for those lives of the babies — I totally agree, but I don’t think you would get that. First, we have the question of whether even if their mothers had nursed whether those babies would have died. Second, even if those babies would not have died had we had 100% breastfeeding rates, I don’t think we would attain that with $15 million. With $15m you would increase the rates, but the reason women do not nurse are not entirely financial — there are social forces at play too.

By the way, the countries you mention have much more homogeneous populations, and much lower poverty rates, combined with more generous parental leave programs. If we instituted these policies, how much would it cost? Would we get the same benefits? Not clear, due to huge difference in demographics, populations, culture, tax structure, etc.

Finally, your comment and reference to a study showing that employers make money on lactation support — this is a very interesting study and I’m glad you pointed it out to me. The links you attached showed that people who nursed were less likely to take sick days for their kids — but unfortunately, the study did not “control for confounders.” This speaks to the question of the difference in the people who nurse versus those who do not. The difference in sickness levels could be due to the nursing, or it could be that those people who nurse are overall healthier and have cleaner child care options, etc. behind why their kids are healthier. This is not based on the absence rates adjusted for confounders. (in fact, it is known that people who nurse tend to be better educated, richer, whiter, less often smokers and have access to better health care combined with those who do not nurse)

Also, while the pamphlet lists some jobs that are blue collar rather than white collar, it is clear that some of their conclusions really only hold for highly trained (translation: well-educated, non-poor) white collar jobs. If you are serving pizza, it does not make a return of $75,000 for your company to give you a few months of maternity leave (as the pamphlet claims, though they don’t specify pizza companies).

From my experience, many women stop nursing when they have to go back to work — even if their work environment is supportive. It’s because they feel that pumping is not professional, or it’s messy, or it’s exhausting, or just inconvenient. If they stay home longer in order to nurse, this is a cost — you can argue it’s worth it, but I disagree that there is no cost to their pocketbooks, or government coffers due to taxes paid by working mothers of young children.

You say not to simplify by comparing minimum wage with the cost of formula. I agree that economic comparisons are tricky and we should not overly simplify. In fact, this is my whole point for ABC’s coverage of the original study. They “simply” looked at health costs that they felt they could attribute to not nursing, and neglected the “costs” that we as a society would have to bear in order to change that. Perhaps a careful analysis would show that the conclusion is still right and we’d be better off financially if almost everyone nursed. However, the way the piece was written, it came off as moralistic. Who would write a research article about the health care costs of the fact that people drive without considering the whole financial picture behind driving, including societal productivity? no one, because there is only a small voice of Americans who believe driving is “wrong.” Again, I am NOT saying that using formula is necessarily cheaper for everyone, but I am humble enough to know that I cannot make the financial decision for someone else (a company or an individual) since everything is so dependent on circumstances. The economics of how it plays out is evidence enough that formula has a beneficial role to play for many families trying to nurture a new family member.

The other reason perhaps you felt that my post didn’t address your points is because I directed the conversation toward the health claims (and the slams against my character). Well, this is because I think that the health concerns (as opposed to the financial ones) are the primary motivators for this conversation to begin with. And of course, everyone wants to defend her reputation when her motives are questioned. You yourself are who said that my comments were sufficiently “outlandish” to merit critical examination of my institutional affiliations. I assure you that they are “clean” of financial bias. Though I would never propose that the fact that some people make their livings through blogs (and I don’t know if you do) that their financial interest trumps their honesty or their critical thinking skills. I hope you can afford me the same respect, though I make my living a s math professor at George Mason University, not as a blogger.

There is a lot I could say about Rebecca Goldin’s reply, but perhaps I’ll start with the easy part (the $$$$).

She said: “And, purely from a financial point of view, the US government would lose tax revenue as well if women stay home to nurse.”

Is that assuming that the women who stay home to nurse would not be replaced by other workers during their absence? In Canada and other countries with paid maternity leave programs, the tax revenues from replacement workers, as well as the fact that more women are able to choose to continue their careers after a paid leave (vs. just staying home outright), essentially pays for the paid leave. There is not a net cost to the economy if mothers stay home to nurse.

She said: “From an individual point of view, it makes even less sense: the personal financial benefit of work, even at minimal wage, eclipses the cost of formula.”

Yes, the salary may well pay for the formula. However, formula is only one of the costs of returning to work. What about day care, transportation, work clothes, more expensive health care, etc. Once you factor in those costs, formula is just one more expense, not the sole expense that a working mother has to pay.

You said: “more than 80% of women stop nursing soon after they leave the hospital, so there is clearly something else going on! I don’t know of any surveys in which women are asked why they stopped nursing/never started nursing (maybe you do) but I don’t think it’s mainly because they had a can of free formula (though maybe for some, this was the reason).”

Yes, a lot of women stop nursing soon after they leave the hospital. This is probably because their milk comes in, they run into problems, and do not have the right support to resolve them. Instead, they have a convenient formula sample handed to them at the hospital, that arrived in the mail, or that a friend or relative gave to them. A Canadian study that I wrote about on my blog found that women who went home with a formula sample were 3.5 times more likely to have supplemented by Week 2 than women who did not take a sample home with them. http://www.phdinparenting.com/2010/03/17/new-study-on-impact-of-free-formula-on-breastfeeding-rates/

Although women do not cite “formula sample” as the reason why they stopped breastfeeding, it is a confounding factor. If they are frustrated with breastfeeding and quality breastfeeding support is not available, but a free can of formula is, they may reach to that. Conflicting advice is one thing that a lot of women mentioned as problematic.

In the Canadian context, the main reasons for early weaning are: low milk supply, low baby weight gain and a baby who seemed uninterested in nursing or nursed ineffectively. In the United States, needing to return to work is likely another one. But with regards to the “technical” reasons women stop nursing (i.e. those Canadian ones I mentioned above), the formula sample becomes a problem when women grab that in the middle of the night while frustrated or when they think “one bottle won’t hurt, right?” instead of working on the problems that they are having. Supplementing can be a slippery slope. Here is the Canadian survey on breastfeeding problems, experiences, etc.: http://www.todaysparent.com/pregnancybirth/breastfeeding/article.jsp?content=20060906_160827_3856

Rebecca, thanks for writing in and sorry for the delay in getting back to you. The fact that 25% of healthy, full-term babies are supplemented unnecessarily IS relevant, as it is precisely unnecessary supplementation that leads to breastfeeding problems and ultimately failure. In baby-friendly hospitals there are far fewer problems breastfeeding, sky-high breastfeeding rates regardless of socio-economic status (and some of these hospitals serve mostly low-income and minority women, which speaks to your later point that women who breastfeed are wealthier, more educated etc.–but they don’t have to be!).

I agree that the infant feeding decision is a risk/reward decision, just like driving etc. The difference is that parents who WANT to breastfeed are being undermined in their efforts, by hospitals that score a D on a breastfeeding report card, by physicians who don’t even refer to lactation consultants which is not covered by health care insurance, by a society which does not value breastfeeding and thinks it is “too expensive” to fix something that would allow mothers to exercise a basic, primal human instinct, regardless of what the benefits are. That to me is something we can not accept. Like you, I suffered unnecessarily in trying to breastfeed, a suffering that probably could have been prevented. I co-founded Best for Babes because I believe all moms deserve to make an informed decision and be cheered on, coached and celebrated without pressure, judgment or guilt, and that all moms who WANT to breastfeed deserve not to be undermined. For many women breastfeeding is not a working option and those mothers deserve to have access to donor milk from a milk bank or formula if that is more feasible.

I apologize for calling your points outlandish, that was perhaps the wrong adjective; however I am still disappointed that you are seeking to poke holes rather than join the fight for what is a female reproductive right; the right to bear and nourish her young, regardless of what science says. I don’t think it would cost as much as you think and I don’t think we should rule the expense out without risking some modest investment of funds to see if we can change the breastfeeding culture and raise breastfeeding rates.

For the record, I am not a blogger and I do not get paid. I run a non-profit, all funds raised go towards educating moms, raising awareness, and beating the “Booby Traps” that keep moms from achieving their personal breastfeeding goals.

I actually totally agree with your points. I am very supportive of breastfeeding (as I have said, I do not support making women feel they are hurting their babies if they do not, but I DO support women who want to nurse, and I TOTALLY agree that hospital support is extremely important).

Personally, I feel that the economics of it are not really the issue — what if it was not economically beneficial to society to have women nurse? By this I mean economically beneficial from every financial aspect that is impacted by the decision to nurse or not. Should we then say that we don’t want to support breast-feeding for women? Of course not, because the benefits can be measured in other, non-economical ways — and underneath the whole discussion is actually exactly this point.

My main reason for writing in is that I take offense at looking at a purported health claim — the claim itself I feel is quite exaggerated to begin with — and its implications to one industry (healthcare) and then using it to “prove” that breast feeding is better for society for financial reasons. If you really look at society as a whole and *all* the costs and benefits (financially), that may or may not be the case, but a simple examination of the attributed health-care costs does not answer the question. On the other hand, it’s not really the right question, is it?

To make a parallel which is rather extreme, people who have children through assisted fertilization (in vitro, artificial insemination) also have higher hospital costs, and an increased number of premature babies, largely due to increased multiples and maternal age. This costs the health care system lots of money. But how could one argue that for this reason, we should encourage women not to go that route? Similarly, older women also tend to have more “expensive” babies through increased complications. Yet, it does not seem to me therefore “wrong” to have a baby over 35. This is just life: a series of sometimes complicated decisions with associated small amounts of risk — and publishing a study which assigns a lot of cost to it is simply unhelpful.

The question really should be: do women get support to nurse? I think many people reading this blog would answer both that they do not, and that they should. But when the question is turned around to say, “Do women realize that they are harming their babies and costing us all money through the billions lost in health care costs?!” it is a destructive, unhelpful (and in my opinion WRONG to boot) message that does not promote the cause (which I share with you) but rather promotes negativity and defensiveness.

Does this defensiveness lead some women to nurse when they wouldn’t otherwise? I don’t think so. The “message” to women that breast feeding is healthy does not come through guilt.

You might ask why I would be such a big supporter of nursing if I think the health claims are exaggerated. The answer is that there are some benefits that are worth the effort for many women. For some women, it *does* make sense financially. For some women, the small health benefits are worth the effort. For some babies such as preemies or those with high risk for diabetes, the health benefits may be a larger consideration and have more consequences. For some women, nursing is part of how they see themselves as mothers. For some women, nursing is a bonding experience. I am sure there are many other reasons too, so don’t knock me for what I have missed! My point is that the decision is very personal and very important to each women, and I couldn’t agree more that they need support to be able to make that decision without feeling that the barriers to nursing are too high.

At the same time, for some women, their time is not worth it financially due to job or time constraints. For some women, their milk doesn’t come in properly or the baby does not thrive on it. For some women, nursing plays no positive role in how they feel for their baby – it can even lead to postpartum depression in some, though it may be the opposite for others. For some women, it makes them feel un-womanly and/or unsexy (I have seen this!). Some women have adopted their babies and cannot nurse for that reason. In all these cases, women who cannot or do not want to nurse need to know that their decision is not greatly harming their child. It is a reasonable decision to give babies formula, and I support them in making it. I agree that it would be wonderful to have enough programs in place so that they are not bullied into using formula or consider it the default choice.

Rebecca, the point of that study is to put pressure on the institutions that are preventing moms from succeeding with breastfeeding. No where does it say “Do women realize that they are harming their babies and costing us all money through the billions lost in health care costs?!”. Perhaps you, like I, are very annoyed with the few very vocal, judgmental activists have taken that stance but that is not the position of the author of the study, who formula fed her child, nor of myself, who formula fed my 1st child, nor of the entire scientific and professional breastfeeding community, nor of most of the advocates I have met. True breastfeeding advocates think that moms do the best they can in the circumstances we are under, but unfortunately for breastfeeding mothers, those circumstances are often AWFUL. Please read our credo and mission and you will see that we absolutely do not tolerate judging or finger-pointing at moms; our whole goal is to take the pressure off moms and put it on the “booby traps”. As for the study, unless we can persuade some of the “booby traps”–including the U.S. government which has not adequately funded proper support for moms and has allowed competing interests to dominate the message to moms–that this is an important issue and could benefit the U.S. government, health insurance companies etc., there will be no funds dedicated and no action taken. Heart disease in women was short-shrifted in funding for decades until advocates came along and demanded funding, using similar studies of the cost to society. Did they get chastised for making people feel guilty for not exercising or for not reducing their risk of a heart attack through diet and regular exercise if possible? Just to give another example, I sometimes let my kids watch TV because I am in a bind, but I don’t interpret every new study saying as a personal attack on me to make me feel guilty! I don’t think any issue has ever been turned into as personal and as judgmental and finger-pointing issue as this one, where any attempts to get more support for moms who WANT to and CAN breastfeed are seen as attempts to make those who don’t or can’t feel guilty. Unfortunately, the formula industry has fanned the flames of the mommy wars, successfully lobbying the government not to release the AHRQ meta-study of 9,000 studies showing the risks of formula, because such information, which parents believe they are entitled to, “would make parents feel guilty”. We need to join together to put pressure on the institutions and the anti-breastfeeding, judgmental culture that are keeping moms from succeeding, and to broaden it so that ALL moms are supported, whether they breastfeed exclusively, partially or not at all.

By the way, do you recommend donated breastmilk from a human milk bank for women who can not breastfeed? It can be requested by prescription for women who can not breastfeed, and for the women who have had mastectomies (as my co-founder did), have suffered sexual abuse, have insufficient glandular tissue or otherwise, it is really the next best choice, and one that we should all work towards making more available!